Preoperative oral gabapentin appears effective in elderly patients

This randomized double-blind study found that oral gabapentin appears effective in elderly patients undergoing elective cataract surgery. Its use reduced anxiety, decreased sedation, required less supplemental midazolam, and was associated with a modest decrease in IOP and faster recovery.

The study compared the use of preoperative gabapentin with preoperative diazepam in 56 elderly patients undergoing cataract surgery.

There was significantly more sedation in the diazepam (control) group than in the gabapentin group. However, there was less subjective anxiety in the gabapentin group than in the control group. Patients in the gabapentin group  also showed a significant reduction in IOP and mean arterial pressure compared with controls. A significantly larger number of patients in the gabapentin group achieved a postanesthesia recovery score of 10 compared with the control group. Control group patients required significantly more perioperative midazolam than those in the gabapentin group.

Postoperatively, pain scores were significantly lower in the gabapentin group, and the number of patients requesting rescue analgesia was significantly lower compared with the control group.

The authors conclude that the dosage of gabapentin they used, 600 mg taken orally, proved to be adequate and free of side effects in patients aged 60 years and older.

However, they add that in general, dose selection for an elderly patient should be cautious, usually starting at the lower end of the dosing range, as was done in this study, reflecting concerns about decreased renal function in this age group, especially as gabapentin is almost totally excreted unchanged in the urine. For elderly patients with pre-existing renal dysfunction, it may be necessary to evaluate the creatinine clearance to determine a safe dose of oral gabapentin.